Sasa Mahmood, Segura Cano Sofía E
Instituto Clodomiro Picado, Universidad de Costa Rica, San José, Costa Rica.
Museo de Zoología, Escuela de Biología, Universidad de Costa Rica, San José, Costa Rica.
Toxicon X. 2020 Jul 30;7:100055. doi: 10.1016/j.toxcx.2020.100055. eCollection 2020 Sep.
Continuous monitoring of the snakebite envenoming allows elucidating factors that affect its incidence at spatial and temporal scales, and is a great tool to evaluate the proper management of snakebite in health centers. To determine if there have been changes over time in snakebite epidemiology in Costa Rica, we conducted a retrospective study using medical records from six hospitals for the years 2012-2013. A total of 475 snakebite patients were treated at the selected hospital during this period. Most bites occurred during the rainy season and primarily affected young men, mainly farm workers and schoolchildren. About 55% of bites occur in peri-domiciliary environments, although its prevalence varies geographically. generates the vast majority of envenoming in the country, which is why the main local symptoms registered are edema, pain, and bleeding disorders. The time elapsed until treatment did not explain the degree of severity at admission. However, complications were observed more frequently in patients who took longer to receive treatment. The primary complications were bacterial infections, whereas kidney failure and compartment syndrome documented at very low frequencies. Only one death was recorded, reflecting the low fatality rate exhibited in the country. Hospital treatment included the rapid administration of antivenom and complementary treatment of antibiotics, analgesics, and antihistamines. The application of the latter as prophylactic does not seem to prevent the appearance of mild early adverse reactions, registered in 22.5% of the cases. Morbidity and mortality rates from snakebite have continued to decrease in the country, as a result of the efforts that Costa Rica has made to improve its public health system. Among those efforts, the creation of primary care centers (EBAIS) has reduced the time to treatment in many regions of the country. The Costa Rican experience of using antivenom in primary health care centers and maintaining good medical records could be considered for application in other countries where snakebite is a major health problem.
对蛇咬伤中毒情况进行持续监测有助于明确在空间和时间尺度上影响其发病率的因素，并且是评估卫生中心对蛇咬伤恰当管理的重要工具。为了确定哥斯达黎加蛇咬伤流行病学随时间是否发生了变化，我们利用2012 - 2013年六家医院的医疗记录进行了一项回顾性研究。在此期间，选定医院共治疗了475名蛇咬伤患者。大多数咬伤发生在雨季，主要影响年轻男性，主要是农场工人和学童。约55%的咬伤发生在住宅周边环境，不过其患病率在地理上有所不同。该国绝大多数中毒情况由此产生，这就是为何记录到的主要局部症状是水肿、疼痛和出血性疾病。直到接受治疗所经过的时间并不能解释入院时的严重程度。然而，在接受治疗时间较长的患者中更频繁地观察到并发症。主要并发症是细菌感染，而肾衰竭和骨筋膜室综合征的记录频率非常低。仅记录到1例死亡，反映出该国的低死亡率。医院治疗包括迅速注射抗蛇毒血清以及抗生素、镇痛药和抗组胺药的辅助治疗。后者作为预防性用药似乎并不能预防2
